This case series summarizes 5 cases of rhino-orbital-cerebral mucormycosis treated at a tertiary hospital in India. All patients had diabetes and/or a history of COVID-19 and corticosteroid treatment. Magnetic resonance imaging showed orbital apex syndrome and cavernous sinus infiltration in all cases. Patients were treated with antifungal drugs, amphotericin B injections, and surgical debridement. One patient died due to complications. Early detection, treatment of predisposing factors, antifungals, and surgery are essential for managing this often fatal infection.
The document discusses black fungus (mucormycosis), which has been affecting some COVID-19 patients in India and Egypt. It provides information on what mucormycosis is, how it spreads, types of mucormycosis infections, clinical features, diagnosis, treatment and prevention. It notes that mucormycosis is caused by exposure to mucor mould commonly found in soil and plants. Improper use of steroids to treat COVID-19 and poor diabetes management are contributing to the increased cases. Treatment involves antifungal therapy like amphotericin B and surgery to remove infected tissues.
The document discusses black fungus (mucormycosis), which has been affecting some COVID-19 patients in India and Egypt. It provides information on:
1) What black fungus is, the types of mucormycosis, and how it spreads (through spore inhalation but not human-to-human).
2) Risk factors like uncontrolled diabetes, steroid use for COVID-19 treatment, and weak immune systems.
3) Symptoms like nasal blockage and eye/orbital involvement.
4) Diagnosis through tissue/fluid samples, imaging, and microscopy of broad, non-septate hyphae.
5) Treatment involving antifungal
The main aim of Corona is transmission of disease from person to person, and it had also been declared as a global pandemic which has caused disaster in the respiratory system of more than five million people and killed more than half a billion people across the world. Patients surviving from Covid-19 have lower immunosuppressive CD4+ T and CD8+ T Cells. And most of the patients are in severe need of mechanical ventilation. This is the reason for a longer stay in hospital for a particular patient. Gradually, these patients have been discovered to develop fungal co-infection. This infection is deadly leading to loss of hearing, loss of sight and eventually death. The fungal infection is referred to as Mucormycosis, the black fungus. The causative agent for this infection is Mucormycotina which is a member of Mucorales. Mucormycotina usually habitats in soil and decaying organic matter. The infection of Mucormycotina is associated with a wide range of human diseases including arthritis, gastritis, renal disorders and pulmonary diseases. This infection is closely associated with the mucous layer of skin, precisely cutaneous layer. This infection is present in the nasal and upper respiratory tract. In the lower respiratory tract these infections are difficult to diagnose and treat due to the lack of precise methods. It was found those neutroponia patients are more
prone to this infection. This is caused by extensive use of chemotherapy resulting in impaired immunity. In recent times, in the case of pulmonary Mucormycosis, necrotizing pneumonia is a major symptom. A combination of antifungal and antimicrobial
agents is being used for a higher clinical recovery in the Mucormycosis case.
This case report describes a 62-year old man with diabetes and chronic renal failure who developed rhino-orbito-cerebral mucormycosis after a tooth extraction. He presented with swelling of the right side of the face and eye symptoms. Imaging showed involvement of the right maxillary sinus and nasal cavity. The patient's condition deteriorated due to poor diabetes control and delayed treatment. Mucormycosis is an opportunistic fungal infection seen in immunocompromised individuals. Prompt diagnosis and aggressive treatment including antifungal therapy and surgery are needed but the patient's systemic conditions and treatment delay were fatal in this case.
Guillain Barre Syndrome & Covid-19: A Case Reportclinicsoncology
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia, headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection.
Guillain Barre Syndrome & Covid-19: A Case Reportpateldrona
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs
Guillain Barre Syndrome & Covid-19: A Case Reportkomalicarol
Besides respiratory symptoms, coronavirus disease 2019
(COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia,
headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection. Guillain barre syndrome (GBS) is a neurological disorder
that usually follows a viral infection, it is possible that COVID-19
infection and GBS are closely related. In this case report, we try to
elucidate the relation between SARS-CoV-2 and GBS.
O ptimization of hyrozycloroquine in mangement of covid 19Ahmed Ali
This document summarizes the potential use of hydroxychloroquine (HCQ) in treating COVID-19. It discusses HCQ's pharmacological properties including its immunomodulatory and antiviral effects. Based on its ability to increase lysosomal pH and disrupt viral fusion and replication, HCQ has demonstrated efficacy against SARS-CoV-1 in vitro and in animal models. The document proposes guidelines for optimizing HCQ's efficacy and safety in COVID-19 treatment, including early administration, loading doses, and continued maintenance doses under medical supervision. More clinical trials are needed to evaluate HCQ specifically for early COVID-19 treatment.
The document discusses black fungus (mucormycosis), which has been affecting some COVID-19 patients in India and Egypt. It provides information on what mucormycosis is, how it spreads, types of mucormycosis infections, clinical features, diagnosis, treatment and prevention. It notes that mucormycosis is caused by exposure to mucor mould commonly found in soil and plants. Improper use of steroids to treat COVID-19 and poor diabetes management are contributing to the increased cases. Treatment involves antifungal therapy like amphotericin B and surgery to remove infected tissues.
The document discusses black fungus (mucormycosis), which has been affecting some COVID-19 patients in India and Egypt. It provides information on:
1) What black fungus is, the types of mucormycosis, and how it spreads (through spore inhalation but not human-to-human).
2) Risk factors like uncontrolled diabetes, steroid use for COVID-19 treatment, and weak immune systems.
3) Symptoms like nasal blockage and eye/orbital involvement.
4) Diagnosis through tissue/fluid samples, imaging, and microscopy of broad, non-septate hyphae.
5) Treatment involving antifungal
The main aim of Corona is transmission of disease from person to person, and it had also been declared as a global pandemic which has caused disaster in the respiratory system of more than five million people and killed more than half a billion people across the world. Patients surviving from Covid-19 have lower immunosuppressive CD4+ T and CD8+ T Cells. And most of the patients are in severe need of mechanical ventilation. This is the reason for a longer stay in hospital for a particular patient. Gradually, these patients have been discovered to develop fungal co-infection. This infection is deadly leading to loss of hearing, loss of sight and eventually death. The fungal infection is referred to as Mucormycosis, the black fungus. The causative agent for this infection is Mucormycotina which is a member of Mucorales. Mucormycotina usually habitats in soil and decaying organic matter. The infection of Mucormycotina is associated with a wide range of human diseases including arthritis, gastritis, renal disorders and pulmonary diseases. This infection is closely associated with the mucous layer of skin, precisely cutaneous layer. This infection is present in the nasal and upper respiratory tract. In the lower respiratory tract these infections are difficult to diagnose and treat due to the lack of precise methods. It was found those neutroponia patients are more
prone to this infection. This is caused by extensive use of chemotherapy resulting in impaired immunity. In recent times, in the case of pulmonary Mucormycosis, necrotizing pneumonia is a major symptom. A combination of antifungal and antimicrobial
agents is being used for a higher clinical recovery in the Mucormycosis case.
This case report describes a 62-year old man with diabetes and chronic renal failure who developed rhino-orbito-cerebral mucormycosis after a tooth extraction. He presented with swelling of the right side of the face and eye symptoms. Imaging showed involvement of the right maxillary sinus and nasal cavity. The patient's condition deteriorated due to poor diabetes control and delayed treatment. Mucormycosis is an opportunistic fungal infection seen in immunocompromised individuals. Prompt diagnosis and aggressive treatment including antifungal therapy and surgery are needed but the patient's systemic conditions and treatment delay were fatal in this case.
Guillain Barre Syndrome & Covid-19: A Case Reportclinicsoncology
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia, headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection.
Guillain Barre Syndrome & Covid-19: A Case Reportpateldrona
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs
Guillain Barre Syndrome & Covid-19: A Case Reportkomalicarol
Besides respiratory symptoms, coronavirus disease 2019
(COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia,
headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection. Guillain barre syndrome (GBS) is a neurological disorder
that usually follows a viral infection, it is possible that COVID-19
infection and GBS are closely related. In this case report, we try to
elucidate the relation between SARS-CoV-2 and GBS.
O ptimization of hyrozycloroquine in mangement of covid 19Ahmed Ali
This document summarizes the potential use of hydroxychloroquine (HCQ) in treating COVID-19. It discusses HCQ's pharmacological properties including its immunomodulatory and antiviral effects. Based on its ability to increase lysosomal pH and disrupt viral fusion and replication, HCQ has demonstrated efficacy against SARS-CoV-1 in vitro and in animal models. The document proposes guidelines for optimizing HCQ's efficacy and safety in COVID-19 treatment, including early administration, loading doses, and continued maintenance doses under medical supervision. More clinical trials are needed to evaluate HCQ specifically for early COVID-19 treatment.
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
Mucormycosis, also known as black fungus, is a serious fungal infection caused by mold of the Mucorales order. It has been increasingly reported in COVID-19 patients, especially in India. Key risk factors include diabetes, steroid therapy for COVID-19, and immunosuppression. Common symptoms include sinusitis, facial swelling and numbness. Diagnosis involves fungal culture, histopathology and imaging. Prognosis is poor if left untreated, with mortality rates reaching 90% for invasive forms. Treatment requires antifungal therapy and surgery.
Mucormycosis is a rare fungal infection caused by Mucorales fungi. It has high mortality and morbidity rates especially in immunocompromised patients like those with diabetes or undergoing chemotherapy. It most commonly presents as rhino-orbito-cerebral infection in India. Diagnosis involves imaging and microscopic identification of broad, non-septate hyphae. Treatment requires intravenous antifungal therapy with amphotericin B and extensive surgical debridement to remove necrotic tissue. Early diagnosis and treatment are essential to improve outcomes.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Patients with severe acute respiratory syndrome coronavirus 2
(SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it
was associated with thrombotic incidents like acute limb ischemia
and pulmonary embolism.
We report 3 cases of COVID-19 infection complicated by arterial
thrombosis in the form of acute limb ischemia.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Awareness Talk on Novel Coronavirus, COVID-19 by Shambaditya Goswami, NIMS Un...Shambaditya Goswami
The document provides an awareness talk on the novel coronavirus (COVID-19). It begins with an introduction that defines COVID-19 and discusses the current global pandemic. It then covers the current status of COVID-19 worldwide and in India, showing decreasing daily new case numbers. It also discusses treatment prospects, including several vaccines in clinical trials in India and evidence that remdesivir may shorten recovery time. General awareness topics like hand hygiene techniques and social distancing are also covered.
Mucormycosis is an invasive fungal infection caused by fungi of the Mucoraceae family. It is an opportunistic infection seen predominantly in patients with diabetes, neutropenia, or other immunocompromised states. The rhinocerebral form involves the facial, orbital, paranasal sinus and cerebral regions. Diagnosis involves biopsy and culture. Treatment requires control of risk factors, aggressive surgical debridement of infected tissues, and antifungal therapy typically with amphotericin B. Despite treatment, mucormycosis has a high mortality rate of 50-85%.
The document provides an overview of COVID-19, including its introduction, pathophysiology, transmission, clinical features, diagnosis, prevention, vaccines, and prognosis. Key points include that COVID-19 is caused by SARS-CoV-2 virus, which binds to ACE2 receptors in the lungs and other organs. It is primarily transmitted through respiratory droplets. Diagnosis involves PCR or CT scans. Prevention strategies include social distancing, masks, and vaccines. Prognosis depends on patient risk factors and can range from mild to critical illness.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
Mucormycosis, also known as black fungus, is an aggressive fungal infection seen in some COVID-19 patients in India. It is caused by a group of molds called mucormycetes that have been opportunistically infecting COVID-19 patients with underlying conditions like diabetes. Common symptoms include sinusitis and black lesions on the nose or face. Diagnosis involves biopsy and microscopic examination showing broad, non-septate fungal hyphae. Treatment requires controlling underlying conditions, antifungal medication like amphotericin B, and sometimes surgery. Despite treatment, mortality remains high, especially for infections affecting the brain or lungs. Prevention involves controlling diabetes and limiting steroid use for COVID-19
This document summarizes a multi-institutional retrospective study on the management of orbital involvement in invasive fungal sinusitis. A total of 47 patients met the inclusion criteria of proven fungal invasion and orbital involvement on imaging within 1 month of symptoms. Of these patients, 14 had extensive intraorbital disease while 33 had limited periosteal involvement. For extensive orbital disease, orbital exenteration was performed early, though survival benefits were unclear. However, for limited orbital disease, conservative management including local antifungal irrigation achieved orbital conservation in 72.7% of patients. The results suggest extensive orbital disease requires early exenteration, while limited disease may be managed conservatively as an alternative to exenteration.
(1) The patient presented with pain, swelling and nasal discharge in the left side of the face for one month. They had a history of diabetes and hypertension.
(2) Clinical examination and investigations revealed elevated blood sugar and low hemoglobin. A provisional diagnosis of squamous cell carcinoma or chronic infection was made.
(3) The final diagnosis was rhino-orbital mucormycosis based on fungal hyphae in biopsy. Treatment involves antifungal therapy, surgical debridement and control of underlying conditions.
This document provides a brief review of contemporary studies on SARS-CoV-2. It discusses the viral classification of SARS-CoV-2 and notes it was first reported in Wuhan, China in 2019. Research has shown SARS-CoV-2 spreads through the air making it more rapidly transmissible between humans. The document also summarizes that the steroid dexamethasone was the first drug shown to reduce deaths from COVID-19 according to a UK clinical trial. Additionally, the humanized monoclonal antibody itolizumab was approved for treating cytokine release syndrome in India. Masks are discussed as providing a critical barrier in reducing transmission when properly fitted by lowering viral concentrations exhaled by asymptomatic and symptomatic individuals.
Evaluation of Signs and Symptoms Post Recovery in COVID Patients: A Questionn...DrHeena tiwari
This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
COVID-19 Associated Large Vessel Thrombosis and Ischemic Stroke: A Case Seriesmahendrareddychirra
The novel severe acute respiratory syndrome coronavirus (SARS-COV-2) affects different people in different ways. Most infected people will develop mild to moderate respiratory flu-like illness and recover without the need for hospitalization.
- A 50-year-old previously healthy man presents to the emergency department with worsening dyspnea and hypoxemia. He has a fever, cough, and fatigue and appears acutely ill. Chest imaging shows bilateral lung opacities. A test detects SARS-CoV-2 RNA in his nasopharyngeal swab.
- Patients with severe COVID-19 may develop acute respiratory distress syndrome and require intubation and mechanical ventilation. Deciding when to intubate is an important consideration. After intubation, lung-protective ventilation should be used.
- Prone positioning, management of thrombosis and renal failure, and treatments such as dexamethasone and remdesivir may benefit patients with
Role of Budesonide in Corona Virus Disease: Systematic Review DrHeena tiwari
Inhaled budesonide has been shown to significantly reduce the likelihood of Covid-19 patients requiring urgent or emergency care or hospitalization when given early to patients with mild symptoms. A systematic review of studies found inhaled budesonide reduced the risk of these adverse outcomes by 91% in one study. It also reduced the median time to recovery by 3 days in another study of patients with risk factors who were not hospitalized. The studies support the potential for inhaled budesonide to control the excessive inflammatory response to Covid-19 and prevent disease progression when administered early in mild cases.
Overseas Medical Students in Ukraine and War-Related Interruption in Educatio...Ahmad Ozair
Roy S#, Bhat V#, Ozair A# ***. Overseas Medical Students in Ukraine and War-Related Interruption in Education: Global Health Considerations from India. Annals of Global Health. 2022 Nov 3;88(1):98. doi: 10.5334/aogh.3926. ([Review Article], # Equal Contribution, PMID: 36380742, Available from: https://pubmed.ncbi.nlm.nih.gov/36380742)
Inequities in Country and Gender Diversity-Based Authorship Representation in...Ahmad Ozair
Bhat V, Ozair A, Bellur S, Subash NR, Kumar A, Majumdar M, Kalra A***. Inequities in Country and Gender Diversity-Based Authorship Representation in Cardiology-Related Cochrane Reviews. JACC Advances. Published Online November 30, 2022. ([Research Letter], Available from: https://www.jacc.org/doi/10.1016/j.jacadv.2022.100140)
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To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
Mucormycosis, also known as black fungus, is a serious fungal infection caused by mold of the Mucorales order. It has been increasingly reported in COVID-19 patients, especially in India. Key risk factors include diabetes, steroid therapy for COVID-19, and immunosuppression. Common symptoms include sinusitis, facial swelling and numbness. Diagnosis involves fungal culture, histopathology and imaging. Prognosis is poor if left untreated, with mortality rates reaching 90% for invasive forms. Treatment requires antifungal therapy and surgery.
Mucormycosis is a rare fungal infection caused by Mucorales fungi. It has high mortality and morbidity rates especially in immunocompromised patients like those with diabetes or undergoing chemotherapy. It most commonly presents as rhino-orbito-cerebral infection in India. Diagnosis involves imaging and microscopic identification of broad, non-septate hyphae. Treatment requires intravenous antifungal therapy with amphotericin B and extensive surgical debridement to remove necrotic tissue. Early diagnosis and treatment are essential to improve outcomes.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Patients with severe acute respiratory syndrome coronavirus 2
(SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it
was associated with thrombotic incidents like acute limb ischemia
and pulmonary embolism.
We report 3 cases of COVID-19 infection complicated by arterial
thrombosis in the form of acute limb ischemia.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Awareness Talk on Novel Coronavirus, COVID-19 by Shambaditya Goswami, NIMS Un...Shambaditya Goswami
The document provides an awareness talk on the novel coronavirus (COVID-19). It begins with an introduction that defines COVID-19 and discusses the current global pandemic. It then covers the current status of COVID-19 worldwide and in India, showing decreasing daily new case numbers. It also discusses treatment prospects, including several vaccines in clinical trials in India and evidence that remdesivir may shorten recovery time. General awareness topics like hand hygiene techniques and social distancing are also covered.
Mucormycosis is an invasive fungal infection caused by fungi of the Mucoraceae family. It is an opportunistic infection seen predominantly in patients with diabetes, neutropenia, or other immunocompromised states. The rhinocerebral form involves the facial, orbital, paranasal sinus and cerebral regions. Diagnosis involves biopsy and culture. Treatment requires control of risk factors, aggressive surgical debridement of infected tissues, and antifungal therapy typically with amphotericin B. Despite treatment, mucormycosis has a high mortality rate of 50-85%.
The document provides an overview of COVID-19, including its introduction, pathophysiology, transmission, clinical features, diagnosis, prevention, vaccines, and prognosis. Key points include that COVID-19 is caused by SARS-CoV-2 virus, which binds to ACE2 receptors in the lungs and other organs. It is primarily transmitted through respiratory droplets. Diagnosis involves PCR or CT scans. Prevention strategies include social distancing, masks, and vaccines. Prognosis depends on patient risk factors and can range from mild to critical illness.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
Mucormycosis, also known as black fungus, is an aggressive fungal infection seen in some COVID-19 patients in India. It is caused by a group of molds called mucormycetes that have been opportunistically infecting COVID-19 patients with underlying conditions like diabetes. Common symptoms include sinusitis and black lesions on the nose or face. Diagnosis involves biopsy and microscopic examination showing broad, non-septate fungal hyphae. Treatment requires controlling underlying conditions, antifungal medication like amphotericin B, and sometimes surgery. Despite treatment, mortality remains high, especially for infections affecting the brain or lungs. Prevention involves controlling diabetes and limiting steroid use for COVID-19
This document summarizes a multi-institutional retrospective study on the management of orbital involvement in invasive fungal sinusitis. A total of 47 patients met the inclusion criteria of proven fungal invasion and orbital involvement on imaging within 1 month of symptoms. Of these patients, 14 had extensive intraorbital disease while 33 had limited periosteal involvement. For extensive orbital disease, orbital exenteration was performed early, though survival benefits were unclear. However, for limited orbital disease, conservative management including local antifungal irrigation achieved orbital conservation in 72.7% of patients. The results suggest extensive orbital disease requires early exenteration, while limited disease may be managed conservatively as an alternative to exenteration.
(1) The patient presented with pain, swelling and nasal discharge in the left side of the face for one month. They had a history of diabetes and hypertension.
(2) Clinical examination and investigations revealed elevated blood sugar and low hemoglobin. A provisional diagnosis of squamous cell carcinoma or chronic infection was made.
(3) The final diagnosis was rhino-orbital mucormycosis based on fungal hyphae in biopsy. Treatment involves antifungal therapy, surgical debridement and control of underlying conditions.
This document provides a brief review of contemporary studies on SARS-CoV-2. It discusses the viral classification of SARS-CoV-2 and notes it was first reported in Wuhan, China in 2019. Research has shown SARS-CoV-2 spreads through the air making it more rapidly transmissible between humans. The document also summarizes that the steroid dexamethasone was the first drug shown to reduce deaths from COVID-19 according to a UK clinical trial. Additionally, the humanized monoclonal antibody itolizumab was approved for treating cytokine release syndrome in India. Masks are discussed as providing a critical barrier in reducing transmission when properly fitted by lowering viral concentrations exhaled by asymptomatic and symptomatic individuals.
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This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
COVID-19 Associated Large Vessel Thrombosis and Ischemic Stroke: A Case Seriesmahendrareddychirra
The novel severe acute respiratory syndrome coronavirus (SARS-COV-2) affects different people in different ways. Most infected people will develop mild to moderate respiratory flu-like illness and recover without the need for hospitalization.
- A 50-year-old previously healthy man presents to the emergency department with worsening dyspnea and hypoxemia. He has a fever, cough, and fatigue and appears acutely ill. Chest imaging shows bilateral lung opacities. A test detects SARS-CoV-2 RNA in his nasopharyngeal swab.
- Patients with severe COVID-19 may develop acute respiratory distress syndrome and require intubation and mechanical ventilation. Deciding when to intubate is an important consideration. After intubation, lung-protective ventilation should be used.
- Prone positioning, management of thrombosis and renal failure, and treatments such as dexamethasone and remdesivir may benefit patients with
Role of Budesonide in Corona Virus Disease: Systematic Review DrHeena tiwari
Inhaled budesonide has been shown to significantly reduce the likelihood of Covid-19 patients requiring urgent or emergency care or hospitalization when given early to patients with mild symptoms. A systematic review of studies found inhaled budesonide reduced the risk of these adverse outcomes by 91% in one study. It also reduced the median time to recovery by 3 days in another study of patients with risk factors who were not hospitalized. The studies support the potential for inhaled budesonide to control the excessive inflammatory response to Covid-19 and prevent disease progression when administered early in mild cases.
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Ozair A, Bhat V, Alisch RS, Khosla AA, Kotecha RR, Odia Y, McDermott MW, Ahluwalia MS***. DNA Methylation and Histone Modification in Low-Grade Gliomas: Current Understanding and Potential Clinical Targets. Cancers (Basel). 2023;15(4): 1342. ([Review Article], IF = 6.6, Available from: https://www.mdpi.com/2072-6694/15/4/1342)
Epidemiology and outcomes of hospital-acquired bloodstream infections in inte...Ahmad Ozair
Tabah A, Buetti N, Staiquly Q … EUROBACT-2 Study Group (including Ozair A). Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Medicine. 2023;1-13. doi:10.1007/s00134-022-06944-2. Published online 2023 Feb 10. (PMID: 36764959, I.F. = 41.7, Available from: https://link.springer.com/article/10.1007/s00134-022-06944-2)
The US Residency Selection Process After the United States Medical Licensing ...Ahmad Ozair
Ozair A, Bhat V, Detchou D. The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators. JMIR Medical Education. 2023;9: e37069. ([Review Article], PMID: 36607718, Available from: https://mededu.jmir.org/2023/1/e37069)
Workshop on Principles of Cancer Epidemiology 2018 Brochure - Christian Medic...Ahmad Ozair
Workshop on
Principles of Cancer Epidemiology.
October 11-13, 2018
Course offered by
Biostatistics Resource and Training Centre,
Clinical Epidemiology Unit,
Christian Medical College, Vellore, India.
In collaboration with the Department of Health Research Methods, Evidence, and Impact (previously Clinical
Epidemiology and Biostatistics) at McMaster University, Ontario, Canada, and the Division of Cancer Epidemiology
and Genetics at the National Cancer Institute, Maryland, United States.
This course’s main purpose is to impart foundational knowledge in
the principles and practice of cancer epidemiology, specifically in
the areas of cancer etiology, surveillance, and survival analysis. The
etiology module will cover the design, analysis, and interpretation
of observational studies. The surveillance module will contain an
overview of the infrastructure needed to conduct cancer
surveillance, aspects of data quality, and tools for using the data
(standardization, age-period-cohort models). Finally, the survival
analysis module will include material related to life tables, survival
curves, survival time models, and the application of survival analysis
to screening trials and evaluation.
Other topics that may be covered include: cancer etiology and
surveillance in the local Indian setting, sample size calculation, and
risk factor surveillance. An important aspect of this course will be
hands-on exercises using examples to understand the theory and its
applications in cancer epidemiology.
Casemix, management, and mortality of patients receiving emergency neurosurge...Ahmad Ozair
This study characterized differences in casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury (TBI) across countries with different levels of human development. The study included 1635 patients from 159 hospitals in 57 countries. Patients' ages, injury mechanisms, and procedures varied significantly between countries. Younger patients in lower HDI countries typically had mild TBI from assaults, while older patients in very high HDI countries usually had moderate or severe TBI from falls. Overall mortality was 18%, and after adjusting for casemix, mortality was higher in medium and high HDI countries compared to very high HDI countries. Significant between-hospital variation in mortality was also observed. This large, global study provides valuable
State of Accredited Endovascular Neurosurgery Training in India in 2021: Chal...Ahmad Ozair
The incidence of stroke has seen over a 100% rise in low- and middle-income countries (LMICs), from 1970-1979 to 2000-2008, while it has stayed nearly the same or decreased in several high-income countries (HICs). However, it has been primarily in HICs that endovascular neurosurgery has evolved to become the standard of care in the management of stroke along with becoming a key modality for managing aneurysms, vascular malformations, carotid artery disease, amongst others. With 30 million individuals suffering from the aforementioned conditions and 7.3% of overall deaths due to stroke alone, India has a particularly high disease burden that can be tackled by neurointerventional therapies. Despite stroke being a leading cause of death and a public health priority in LMICs like India, provision of endovascular neurosurgical care is extremely scarce, both in its infrastructure and the number of trained subspecialist practitioners. This opinion piece utilizes the case scenario of India to highlight how the disparity of endovascular neurosurgical care exists in the face of excellent training and delivery of general neurosurgery and its other subspecialties and highlights key recommendations. One major reason, which this article focuses upon, is the near complete lack of accredited subspecialty training in endovascular care for neurosurgeons in India in 2021. Given that the majority of neurosurgery fellowships in India are currently non-accredited in nature, professional neurosurgical societies in LMICs will play a key role in supporting fellowship accrediting bodies. With the absolute dearth of dedicated neuroendovascular training during neurosurgery residency in developing countries, coupled with the unique and specific needs of this subspeciality, it will be the establishment of high-quality, accredited fellowships that would be crucial for having the framework for delivering endovascular care.
Percutaneous image-guided cryoablation of spinal metastases: A systematic reviewAhmad Ozair
Percutaneous cryoablation (PCA) is a minimally invasive technique that has been recently used to treat spinal metastases with a paucity of data currently available in the literature. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective or retrospective studies concerning metastatic spinal neoplasms treated with current generation PCA systems and with available data on safety and clinical outcomes were included. In the 8 included studies (7 retrospective, 1 prospective), a total of 148 patients (females = 63%) underwent spinal PCA. Tumors were located in the cervical (3/109 [2.8%], thoracic (74/109 [68.8%], lumbar (37/109 [33.9%], and sacrococcygeal (17/109 [15.6%] regions. Overall, 187 metastatic spinal lesions were treated. Thermo-protective measures (e.g., carbo-/hydro-dissection, thermocouples) were used in 115/187 [61.5%] procedures. For metastatic spinal tumors, the pooled mean difference (MD) in pain scores from baseline on the 0–10 numeric rating scale was 5.03 (95% confidence interval [CI]: 4.24 to 5.82) at a 1-month follow-up and 4.61 (95% CI: 3.27 to 5.95) at the last reported follow-up (range 24–40 weeks in 3/4 studies). Local tumor control rates ranged widely from 60% to 100% at varying follow-ups. Grade I-II complications were reported in 9/148 [6.1%] patients and grade III-V complications were reported in 3/148 [2.0%]) patients. PCA, as a stand-alone or adjunct modality, may be a viable therapy in appropriately selected patients with painful spinal metastases who were traditionally managed with open surgery and/or radiation therapy.
Pediatric Brain Tumors: From Modern Classification System to Current Principl...Ahmad Ozair
Central nervous system (CNS) malignancies contribute significantly to the global burden of cancer. Brain tumors constitute the most common solid organ tumors in children and the second most common malignancies of childhood overall. Accounting for nearly 20% of all pediatric malignancies, these are the foremost cause of cancer-related deaths in children 0-14 years of age. This book chapter provides a state-of-the-art overview of pediatric brain tumors. It discusses their morbidity and mortality and introduces the WHO 2021 classification of CNS tumors, which is critical to therapeutic decision-making. It then describes the modern understanding of tumor grading and its clinical implications, followed by the general principles of diagnosis and management. The chapter then discusses, in detail, those brain tumors which have the highest disease burden in children, including medulloblastoma, astrocytoma, ependymoma, schwannoma, meningioma, amongst others. The landscape of treatment of pediatric brain tumors has been rapidly evolving, with several effective therapies on the horizon.
Scrub Typhus Presenting with Hemiparesis: Case Report of a Rare ManifestationAhmad Ozair
We here present a case of scrub typhus (ST) manifesting with hemiparesis, which, to the best of our knowledge, has been reported few times prior. ST typically presents with headache, fever, cough, dyspnoea, and/or gastrointestinal symptoms. Early treatment ensures swift improvement. However, this common cause of febrile illness is often overlooked, even in endemic regions. This is due to a nonspecific presentation, low index of suspicion, and lack of diagnostic facilities. Even our institution, an apex public referral center of northern India, lacked affordable testing a decade ago. After testing began, a significant number of cases, which would have previously been labeled as “fever of unknown origin,” were found to be of ST and confirmed by response to doxycycline.
Large Cerebral Infarction in Tuberculous Meningitis: Case Report of an Uncomm...Ahmad Ozair
We here present an illustrative case of tuberculous meningitis (TBM) with a rare complication of large cerebral infarction. TBM is the most common type of chronic CNS infection in developing countries.[1] Strokes occur in 15–57% of TBM cases; mostly being associated with advanced illness.[2] An 18-year-old male was brought to a tertiary care centre in northern India with high-grade fever and headache for 3 months; followed by right-sided bodily weakness and inability to speak, for a week. He was conscious, having neck rigidity, positive Kernig's sign, global aphasia, and hemiplegia. Brain MRI suggested basal exudates, hydrocephalus, and tuberculoma in the left cerebellar hemisphere. Diffusion-weighted imaging indicated large infarct involving anterior cerebral artery (ACA) and middle cerebral artery (MCA) territories [Figure 1]. Guarded lumbar puncture was done in view of focal deficit and mass effect. CSF analysis revealed protein 3.5 g/L, glucose 1.66 mmol/L (blood glucose 7.2 mmol/L), leukocyte count of 250 with lymphocytosis, and positive Gene Xpert MTB/RIF assay. He was started on first-line anti-tuberculosis therapy (ATT), steroids, and aspirin. After 3 months, his fever and headache had improved but he still had hemiparesis and aphasia, confirming the diagnosis of grade 3 TBM. After 12 months of ATT coverage and follow-up, his motor function had improved with some residual deficits.
Letter: Is the Stupp Protocol an expensive and unsustainable standard of care...Ahmad Ozair
Glioblastoma multiforme (GBM) is the most common and aggressive primary adult brain neoplasm with an age-adjusted incidence rate of 3.22 per 100 000 individuals and a 5-yr survival rate of 6.8%.1 In 2005, Stupp and colleagues proposed maximal safe resection, concomitant temozolomide (TMZ) with radiotherapy, and adjuvant TMZ as the optimal treatment. Implementation of the Stupp protocol in high-income countries (HICs) has resulted in increased survival compared to previous regimens. With little-to-no literature on the management and outcomes of patients with GBM in low- and middle-income countries (LMICs), it is unclear whether the Stupp protocol is being adopted or whether it is, or ever can be, the optimal strategy in LMICs...
Learning to practice medicine during COVID-19 and mucormycosis epidemics: an ...Ahmad Ozair
The COVID-19 pandemic has greatly affected medical education and training experiences for interns and resident doctors. As medical schools shifted their teaching curriculum to virtual platforms, most senior medical students lacked sufficient clinical exposure as they missed out on in-hospital rotations before beginning their intern year. In this article, we share our experience in transitioning from medical school to our intern year while working in COVID and non-COVID facilities. We discuss our challenges while learning basic skills in a resource-limited setting during a period of high patient mortality because of COVID-19 and Mucormycosis.
Medical Students in Global Neurosurgery: Rationale and RoleAhmad Ozair
Approximately 5 million essential neurosurgical cases are unmet each year, all in low- and middle-income countries (1). After the Lancet Commission on Global Surgery described the absence of global surgery from global health discourse in January 2014 (2), the field of neurosurgery quickly recognized the importance of increasing equity in care globally (3-5). Although existing initiatives in global neurosurgery have focused on neurosurgeons and trainees, medical students represent a promising group for sustainable long-term engagement. We characterize why medical students are fundamental to success, outline the importance of incorporating medical students, and delineate how to increase medical student interest and participation in global neurosurgery.
Impaled roadside guardrail in the neck: Case of a failed motorcycle stuntAhmad Ozair
Trauma is currently the leading cause of death in the age group 15 to 44 years globally, with road trauma now representing the sixth leading cause of death worldwide. We present a case of a young male, who was brought to the apex trauma centre of the province with a metallic roadside guardrail impaled in his neck up to his oral cavity, which had to be cut to transport him to the hospital. A meticulous local exploration resulted in the successful removal of the spiked guardrail, with no damage to critical structures. We discuss the paradigm changes in and the expertise required for the management of such penetrating neck injuries (PNIs). For family physicians, this case represents one of the wide variety of cases they will be called to help upon and administer prehospital care. Thus, utilization of principles of basic life support, recognition of the severity of road trauma cases, and ensuring urgency of referral by general practitioners are all critical.
Scrub typhus manifesting with intracerebral hemorrhage: Case report and revie...Ahmad Ozair
Scrub typhus (ST), hitherto absent from many parts of India, is now recently being recognized as a significant cause of morbidity and mortality throughout the country. Its diverse clinical presentations, low of the index of suspicion by the treating physician, and lack of diagnostic testing in many parts of the country result in delayed treatment, leading to a host of complications. We here report such a complication, where ST manifested with a large intracerebral hemorrhage, of which, to the best of our knowledge, only nine cases have been reported in the English language worldwide. Family physicians, who are the often first point of contact for treatment of febrile illness, as ST typically manifests, need to be aware of this entity to prevent such catastrophic consequences.
Bilateral limb gangrene in an HIV patient due to vasculopathy: Managing the d...Ahmad Ozair
Patients with human immunodeficiency virus (HIV) have been reported to experience a spectrum of homeostatic dysregulation and resulting manifestations in their vascular system. This may be due to either disruption in the coagulation-anticoagulation pathways or due to damage to vessels from either HIV or other opportunistic infections. However, gangrene in an HIV-infected patient is an uncommon phenomenon. We herein report a case of a 30-year-old female, who had been taking antiretrovirals irregularly for 10 years, developing bilateral limb gangrene during her hospitalization for cryptococcal meningitis. Unfortunately, her condition continued to deteriorate and her attendants took her from the hospital against medical advice, with her death soon after. We illustrate how several biopsychosocial factors came together here to result in poor outcomes. To note, peripheral arterial disease (PAD) in HIV can rapidly lead to critical limb ischemia, resulting in limb gangrene. Aggravating risk factors for the same include smoking, poor glycemic control, and/or low CD4 T-cell count (<200 cells/mm3). General practitioners should be aware that HIV patients are far more prone to PAD than the normal population. Early recognition of at-risk patients, both medically and psychosocially, by family physicians is thus critical.
This case report describes a 27-year-old female who presented with 10 days of fever followed by altered sensorium, jaundice, and diplopia. She was found to have right lateral rectus palsy. Testing found positive IgM antibodies for scrub typhus, dengue, and chikungunya. Based on the clinical presentation and response to doxycycline treatment, scrub typhus was determined to be the cause. This represents one of the rare reported cases of isolated lateral rectus palsy caused by scrub typhus. Family physicians should be aware of the availability of affordable scrub typhus testing in India and consider it as a potential cause of fever of unknown origin given its endemicity in
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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2. tissue specimen was obtained from the left nasal cavity and was suggestive of mucormycosis. Two weeks
after the diagnosis of mucormycosis, the patient developed right-sided sudden onset weakness, left-sided
seventh nerve palsy, and slurring of speech. Random blood sugar (RBS) at the time of admission was 225
mg/dl. Magnetic resonance imaging (MRI) of the brain, orbits, and paranasal sinuses revealed left-sided
erosions of medial and inferior walls of the orbit with involvement of intra- and extraconal fat, bulky
muscles displaying heterogenous post-contrast enhancement, optic neuritis, superior orbital fissure, orbital
apex involvement, proptosis, and panophthalmitis. Left-sided cavernous sinus infiltration with loss of flow
voids in C2, C3, and C4 in the internal carotid artery (thrombosis) and acute lacunar infarcts in cerebral
hemispheres, gangliocapsular region, and corona radiata were present. Right and left-sided maxillary,
ethmoid, sphenoid, frontal, and superior alveolar processes were involved. The patient was administered
liposomal amphotericin B, posaconazole, and trans-cutaneous retrobulbar amphotericin-B (TRAM-B).
Orbital exenteration and endonasal endoscopic debridement were performed. A few days after surgery, the
patient developed sudden deterioration in consciousness with a Glasgow coma scale (GCS) score of 3/15 and
was transferred to the infectious diseases intensive care unit (ICU), where he was intubated and ventilated.
The patient died on the same day.
Case two
A 67-year-old gentleman with diabetes mellitus controlled on oral hypoglycemics presented with left eye
swelling and restricted movements, headache, pain in the lower jaw, and loss of sensation on the left side of
the face. One month earlier, the patient had developed fever and shortness of breath, for which he was
administered oral steroids. A reverse transcriptase-polymerase chain reaction (RT-PCR) done on admission
confirmed the COVID-19 positive status of the patient. On examination, left-sided lower motor neuron
facial nerve palsy was present. On torchlight examination, periorbital edema and chemosis were present. A
tissue specimen was obtained from the left nasal cavity, and mucormycosis was diagnosed. Biochemical
investigations revealed increased values of C-reactive protein (CRP) (38.9 mg/L), procalcitonin (0.8 ng/ml),
serum ferritin (433 ng/ml), fibrinogen (489 mg/dl), RBS (174 mg/dl), haemoglobin (Hb) (9.4 g/dl), and mild
leucocytosis (13,000). MRI of the brain, orbits, and paranasal sinuses revealed left-sided nasolacrimal duct
involvement, erosions of medial and inferior walls of the orbit with involvement of intra- and extraconal fat
and extension up to preseptal compartment, bulky muscles displaying post-contrast enhancement, optic
neuritis, superior orbital fissure, and orbital apex involvement. Left-sided cavernous sinus infiltration and
an enhancing dural thickening along the anterior temporal lobe were present. Right and left maxillary,
ethmoid, sphenoid, and frontal sinuses were involved with right-sided erosion of anterior and medial walls.
The patient was administered liposomal amphotericin B, posaconazole, isauvaconazole, and TRAM B.
Endonasal endoscopic debridement was performed. The patient was discharged after two months. The
patient has maintained regular follow-ups since then and has been taking posaconazole.
Case three
A 42-year-old gentleman presented with a headache, pain in the left eye, and diplopia for the past 20 days.
The patient had a history of treatment with broad-spectrum antimicrobials for an upper respiratory tract
infection one month prior to the development of symptoms of mucormycosis. The patient was never tested
for COVID-19 before presentation, where RT-PCR for COVID-19 was done and was negative. The patient was
not a known case of diabetes and had no history of steroid administration. On torchlight examination of
eye, periorbital edema and chemosis were present. A tissue specimen was obtained from the left nasal cavity,
and mucormycosis was diagnosed. Biochemical investigations revealed increased values of CRP (20.5 mg/L),
fibrinogen (425 mg/dl), decreased Hb (9 g/dl), and leucocytosis (14,500). The patient was administered
antibacterials for sinusitis, liposomal amphotericin B, and posaconasole. Three injections of TRAM B were
given, and endoscopic endonasal debridement was performed. MRI of the brain, orbits, and paranasal
sinuses revealed left-sided erosion of medial and inferior walls of the orbit with involvement of intra- and
extraconal fat and extension up to the preseptal compartment, bulky muscles displaying post-contrast
enhancement, optic neuritis, superior orbital fissure, and orbital apex involvement. Cavernous sinus
infiltration and an enhancing dural thickening along the anterior temporal lobe were present on both left
and right sides. Right and left maxillary, ethmoid, sphenoid, and frontal sinuses were also involved. The
patient was discharged after two months and is currently alive and well and is compliant with regular
follow-up.
Case four
A 50-year-old gentleman with newly diagnosed diabetes presented to us with headaches, diminished vision
in the right eye, and diplopia for the past 15 days. One and a half months before admission, he developed a
fever and cough and subsequently tested positive for COVID-19 on RT-PCR. He was treated with
supplemental oxygen through a nasal cannula and oral steroids for 10 days. Upon admission for the
following symptoms, he tested negative on RT-PCR. On examination, right periorbital edema and right
cheek swelling were noted. The nasal septum was deviated to the right, and discharge was present in the
right nasal cavity. The right eye was nonreactive to light, and the pupil was dilated. Ocular movements in the
right eye were restricted in all gazes. Nasal debridement was performed, and the tissue sample was sent for
histopathology, which confirmed the diagnosis of mucormycosis. Lab investigations revealed elevated CRP
(29 mg/L), d-dimer (0.6 ug/L), lactate dehydrogenase (LDH) (586 IU/L), ferritin (323 ug/L), IL-6 (26 pg/ml),
and procalcitonin (0.2 ng/ml); Hb (11.1 g/dl) was reduced. MRI of the brain, orbits, and paranasal sinuses
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 2 of 9
3. revealed right-sided optic neuritis, bulky ocular muscles displaying post-contrast enhancement, orbital apex
involvement, and mucoperiosteal erosion of the medial wall of the left orbit with extraconal fat stranding.
The right cavernous sinus was diffusely infiltrated, flow void was noted in the right ICA, dural enhancement
was noted along the right base frontal lobe, and frontal and temporal lobe cerebritis was present. Right and
left maxillary, ethmoid, sphenoid, and frontal sinuses were involved. The patient was administered
antibacterials for sinusitis, liposomal amphotericin B, posaconazole, and hyperbaric oxygen therapy. Three
injections of TRAM B were given, and endoscopic endonasal debridement was performed. The patient was
discharged after two and half months and is currently alive and well. He is still taking posaconazole syrups
and is compliant with follow-up.
Case five
A 44-year-old gentleman with a history of diabetes for the past 10 years (controlled on oral hypoglycemics)
presented to us with bilateral loss of vision and pain in the upper jaw for 28 days. He had contracted COVID-
19 a month prior to presentation and tested positive on RT-PCR. Subsequently, he developed COVID-19
pneumonia and was treated with broad-spectrum antimicrobials along with oral steroids for four days. Upon
admission for the following symptoms, he tested negative on RT-PCR. On examination, a diffuse swelling
was noted on the right side of his face, which was tender to touch. Periorbital edema was present. Nasal
debridement was performed, and the tissue sample was sent for histopathology, which confirmed the
diagnosis of mucormycosis. Lab investigations revealed random plasma glucose of 180 mg/dl, reduced Hb
(11.3g/dl), CRP (48 mg/dl), and d-dimer (0.8 ug/ml). MRI of the brain, orbits, and paranasal sinuses revealed
right-sided erosions of medial and inferior walls with involvement of intra- and extraconal fat, optic
neuritis, superior orbital fissure, and orbital apex involvement. Focal infiltration of the cavernous sinus and
cribriform plate involvement were present on the right side. Right-sided maxillary sinus was involved with
soft tissue filling in the maxillary antrum, causing erosion of medial, lateral, and anterior walls. The
ethmoid sinus and sphenoid sinus were involved with the involvement of the greater wing. The superior
alveolar process is involved. Left-sided maxillary and sphenoid sinus were involved. The T1-weighted
MRI head findings of this case are displayed in Figures 1, 2. The patient was administered antibacterials for
sinusitis, liposomal amphotericin B, posaconazole, and TRAM B. Endoscopic endonasal debridement was
performed. The patient was discharged after two and half months and is currently alive and well. He is still
taking posaconazole syrups and is compliant with follow-up.
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 3 of 9
4. FIGURE 1: T1-weighted MRI head (axial section) of Case Five showing
right maxillary sinusitis and infiltration (red arrow), and nasal septum
deviation (green arrow)
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 4 of 9
5. FIGURE 2: T1-weighted MRI head (coronal section) of Case Five
showing right maxillary sinusitis and infiltration (red arrow)
The clinical and demographic profiles along with the initial complaints and MRI findings of the five cases of
rhino-orbito-cerebral mucormycosis are given in Tables 1, 2.
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 5 of 9
6. Parameters Case 1 Case 2 Case 3 Case 4 Case 5
Age 70 67 42 50 44
Sex Male Male Male Male Male
History of COVID-19 Yes Yes No Yes Yes
History of broad-spectrum antimicrobials Yes Yes Yes Yes Yes
History of diabetes mellitus Yes Yes No Yes Yes
Obesity No No No Yes No
History of hypertension No Yes No Yes No
History and duration of oral steroids No Yes No Yes Yes
History of IV steroids Yes No No No No
Occular involvement Yes Yes Yes Yes Yes
CNS involvement Yes Yes Yes Yes Yes
AKI during hospital stay No Yes No No Yes
Anaemia during hospital stay No Yes No No Yes
PNS involvement Yes Yes Yes Yes Yes
Outcome Death Survived Survived Survived Survived
TABLE 1: Clinical and demographic profiles and risk factors of rhino-orbito-cerebral
mucormycosis patients
CNS: central nervous system; AKI: acute kidney injury; PNS: para-nasal sinuses; COVID-19: coronavirus disease 2019
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 6 of 9
7. Cases
Initial
complaints
Occular involvement CNS involvement PNS involvement
CASE
1
Left eye
swelling,
bilateral
nasal
obstruction,
and nasal
discharge
Left-sided: Erosion of medial and
inferior walls and involvement of intra-
and extraconal fat. All muscles are
bulky and are displaying post-contrast
enhancement. Optic neuritis present,
and superior orbital fissure and orbital
apex involved. Panophthalmitits
present.
Left-sided: Cavernous sinus
infiltration and loss of flow
voids in C2, C3, and C4 in
ICA; thrombosis present.
Acute lacunar infarcts in
cerebral hemispheres,
gangliocapsular region and
corona radiata present.
Right and left-sided maxillary, ethmoid,
sphenoid and frontal sinuses and
superior alveolar process involved.
CASE
2
Left eye
swelling,
restriction of
movement
of left eye,
and
deviation of
angle of
mouth to the
right side.
Left-sided: Nasolacrimal duct involved.
Erosions of medial and inferior walls
with involvement of intra- and
extraconal fat and extension up to
preseptal compartment. All muscles
bulky, displaying post-contrast
enhancement. Optic neuritis present
and superior orbital fissure and orbital
apex involved.
Left-sided: Cavernous sinus
infiltration and enhancing dural
thickening along anterior
temporal lobe present.
Right and left-sided maxillary, ethmoid,
sphenoid, frontal sinuses involved.
CASE
3
Headache,
left-sided
uniocular
diplopia,
and pain
around left
eye
Left-sided: Erosion of medial and
inferior walls and involvement of intra-
and extraconal fat. All muscles are
bulky and are displaying post-contrast
enhancement and extension up to
preseptal compartment. Optic neuritis
present and superior orbital fissure and
orbital apex involved.
Left-sided: Cavernous sinus
infiltration and enhancing dural
thickening along para
cavernous region present.
Cribriform plate eroded. Right-
sided: Enhancing dural
thickening along para
cavernous region. Cribriform
plate focally eroded.
Right-sided: Maxillary, ethmoid and
sphenoid sinuses involved. Left-sided:
Maxillary, sphenoid, ethmoid and
frontal sinuses involved.
CASE
4
Right sided
headache,
and right
sided loss
of vision
Right-sided: All ocular muscles bulky,
displaying post-contrast
enhancement. Optic neuritis present
and orbital apex involved. Left-sided:
Mucoperiosteal erosion of medial wall
of left orbit with extraconal fat
stranding..
Right-sided: Diffusely infiltrated
right cavernous sinus. Flow
void noted in Right ICA. Dural
enhancement noted along
right basifrontal lobe. Frontal
and temporal lobe cerebritis
present.
Right and left maxillary, ethmoid,
sphenoid, frontal sinuses involved.
CASE
5
Blurring of
vision right
eye, and
pain in
upper right
jaw.
Right-sided: Erosions of medial and
inferior walls with involvement of intra-
and extraconal fat. Optic neuritis
present and superior orbital fissure and
orbital apex involved.
Right-sided: Focal infiltration of
cavernous sinus and cribriform
plate involved.
Right-sided: Maxillary sinus involved
with soft tissue filling in maxillary
antrum causing erosion of medial,
lateral and anterior walls. Ethmoid
sinus involved. Sphenoid sinus
involved with involvement of greater
wing superior alveolar process. Left-
sided: Maxillary sinus and sphenoid
sinus involved.
TABLE 2: Initial complaints and MRI findings of rhino-orbito-cerebral mucormycosis patients
CNS: central nervous system; PNS: para-nasal sinuses; ICA: internal carotid artery
Discussion
The second wave of COVID-19 in India did not only present with acute infections and post-infective
pneumonia but also opportunistic infections in patients who were either immunocompromised,
uncontrolled diabetics, or treated with high-dose oral or intravenous steroids. The incidence rate of
mucormycosis globally varies from 0.005 to 1.7 per million population [15]. In India, the prevalence of
mucormycosis is estimated at 140 per million population, which is about 80 times higher than the
prevalence in developed countries [16]. In comparison with the background prevalence of mucormycosis in
comorbid populations, the prevalence of COVID-19-associated mucormycosis was 50 times higher than the
highest documented prevalence of mucormycosis that was among diabetic patients in India (0.14 cases per
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 7 of 9
8. 1000 patients) [16].
Prior to the COVID-19 pandemic, mucormycosis was most commonly reported in severely
immunocompromised patients with uncontrolled diabetes [1]. In some patients, it was a diabetes-defining
illness. The most common clinical presentation of mucormycosis is rhino-orbital-cerebral infections.
Hyperglycemia, usually with an associated metabolic acidosis, is the most common underlying condition [1].
The infection usually presents as acute sinusitis with fever, nasal congestion, purulent nasal discharge,
headache, and sinus pain. All of the sinuses become involved and spread to contiguous structures, such as
the palate, orbit, and brain usually progress rapidly over the course of a few days. The hallmarks of spread
beyond the sinuses are tissue necrosis of the palate resulting in palatal eschars, destruction of the
turbinates, perinasal swelling, erythema, and cyanosis of the facial skin overlying the involved sinuses
and/or orbit. Signs of orbital involvement include periorbital edema, proptosis, and blindness. Facial
numbness is frequent and results from infarction of sensory branches of the fifth cranial nerve. Spread from
the sphenoid sinuses to the adjacent cavernous sinus can result in cranial nerve palsies, thrombosis of the
sinus, and involvement of the carotid artery. Diagnosis is made by obtaining specimens during endoscopic
evaluation, which are inspected for broad, non-septate hyphae with right-angle branching. Further
evaluation for the extent of spread of the infection is done by computed tomography (CT) or MRI. Several
cases were admitted to the mucormycosis wards in our institute in April-July 2021 and were considered a
breakthrough in the incidence of this rare type of fungal infection.
In this case series, we reported five cases of post-COVID 19 mucormycosis that presented with sinusitis and
focal neurological deficits to the medicine department of King George’s Medical University during the
second wave of COVID-19 pandemic in India in the months of April-May, 2021. All five were above 40 years
of age and had mucormycosis confirmed by histopathology. Four out of five patients had a history of or were
diagnosed with COVID-19 infection when they presented with symptoms of mucormycosis. All of them had
a history of administration of broad-spectrum antimicrobials. All the cases had a history of non-invasive
oxygen supplementation. Of the patients, 80% were previously diagnosed as diabetics and/or were treated
with high-dose corticosteroids for COVID 19; both are considered risk factors for immunosuppression.
Insulin was used to treat the deranged glycemic status caused by the use of high-dose steroids. Two of these
cases were known cases of hypertension, and one of them had obesity. All the cases had disease
involvement in the eye, CNS, and paranasal sinuses. Reduction in visual acuity in cases with mucormycosis
is explainable on the basis of infarctions in blood vessels supplying the retina or optic nerve, compression
on the nerve along its course within the cavernous sinus, or direct infection and necrosis [12,13]. Optic
neuritis, orbital apex involvement, and cavernous sinus infiltration were present in all the cases. Patient
one, who developed right hemiparesis and left upper motor neuron (UMN) seventh nerve palsy, also had
acute lacunar infarcts in cerebral hemispheres, gangliocapsular region, and corona radiata. All the patients
were treated with multiple doses of antimicrobials, liposomal amphotericin B, posaconazole/isavuconazole
syrups, and TRAM B. Hyperbaric oxygen therapy was given to patient two and patient four. Endoscopic nasal
debridement was performed on all patients. Orbital exenteration was only performed on Patient one.
Patients two and five were operated on by the oro-maxillo-facial surgery (OMFS) department. Case series
from India exhibit overall mortality of 15-31% in cases of mucormycosis [14]. In this case series, the
mortality was 20%.
According to the World Health Organisation (WHO), COVID-19 vaccines provide strong protection against
serious illness, hospitalization, and, therefore, the development of mucormycosis later [17].
Conclusions
Mucormycosis is a very rare phenomenon, but during the second wave of the COVID-19 pandemic in India,
it was unfortunately widespread and associated with significant morbidity and mortality. The major learning
point is that in a patient with recent history of COVID-19 infection, uncontrolled diabetes mellitus, and
high-dose steroid supplementation are the most important risk factors for the development of
mucormycosis.
The essential elements for successfully managing this fatal infection are controlling the predisposing
factors, early detection with a high index of suspicion in patients with contributing factors, anti-fungal
drugs, and surgical debridement of the involved tissues. Amphotericin-B-associated nephrotoxicity is a
severe cause of morbidity during the treatment of mucormycosis patients. Hence, such patients should
receive special care by adequate hydration and regular renal function tests. COVID-19 vaccines provide
strong protection against serious illness, hospitalization, and, therefore, the development of mucormycosis
later.
Additional Information
Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In
compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services
info: All authors have declared that no financial support was received from any organization for the
2022 Singh et al. Cureus 14(8): e27906. DOI 10.7759/cureus.27906 8 of 9
9. submitted work. Financial relationships: All authors have declared that they have no financial
relationships at present or within the previous three years with any organizations that might have an
interest in the submitted work. Other relationships: All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted work.
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